CommercialBilling CodesMedium impact
11.03.17a, Peroral Endoscopic Myotomy (POEM) Procedures
Independence Blue Cross·Gastroenterology, General Surgery·Medical Policy
Effective date
Jan 5, 2026
We identified it
Sep 3, 2026
Summary
Independence Blue Cross updated POEM policy (11.03.17a) effective 01/05/2026, replacing CPT code 43999 with CPT code 43499 for diverticular and Zenker POEM procedures. Coverage remains limited to achalasia type III only; D-POEM, Z-POEM, and G-POEM remain experimental/investigational and not covered. Billing teams must update systems to use the new code 43499 for these experimental procedures.
Action Required
By 01/05/2026: Billing team must update billing system and claims submission processes to replace CPT code 43999 with CPT code 43499 for diverticular POEM (D-POEM) and Zenker POEM (Z-POEM) procedures. Note that both codes represent experimental/investigational procedures and will NOT be reimbursed by Independence Blue Cross. Update internal coding references and provider documentation templates. Verify that claims for these procedures are properly denied as non-covered experimental services. Confirm that CPT 43497 (standard POEM for achalasia type III with Eckardt score >6) remains the only covered POEM procedure. Communicate the code change to any providers who perform these procedures.